[Outcome and cost of mechanical ventilation in patients with inoperable solid tumors and hematologic malignancies]

The application of mechanical ventilation can be life-saving in patients with acute respiratory failure, but is frequently ineffective in terminally ill patients. To analyze the outcome and cost of mechanical ventilation for patients with malignancies, we retrospectively reviewed 115 patients with inoperable solid tumors or hematologic malignancies who received mechanical ventilation. Eighty eight of these 115 patients (77%) died while on mechanical ventilation; 18 patients (16%) were weaned from mechanical ventilation but still died during their hospitalization. Six patients (5%) were discharged but survived less than 3 months and only three patients (3%) survived for more than 3 months after discharge. The total time of mechanical ventilation was 772 person-days, which represented 5.5% (772/13974) of the total mechanical ventilator use in our hospital in 1993. The total hospital cost from initiation of mechanical ventilation to discharge or death of these 115 patients was NT $11,238,022 (US $432,200) and daily hospital cost per person during mechanical ventilation was approximately NT $10,845 (US $420). The "daily cost of discharge survival" (defined as total hospitalization cost from the initiation of mechanical ventilation to discharge or death divided by total discharge person-days) for patients with inoperable solid tumors was NT $73,421 (US $2,820)/per person-day. We concluded that mechanical ventilation should not be routinely used in patients with inoperable solid tumors and hematologic malignancies. Physicians should explain the poor outcome to these patients and their families in advance and inquire about their willingness to forego mechanical ventilation.